Wedgie Time for Peter Orszag?

Did anybody else read this anti-summer break piece by Peter Orszag and feel the urge to give the author a tremendous wedgie?

The question is posed semi-seriously because I wonder if I’m reading this piece too much through the lens of someone who followed Orszag’s shaping of and advocacy for Obamacare and found it contemptible.

Recall that Orszag was director of President Obama’s Office of Management and Budget who touted the long-term effects of the government taking control of even more of America’s healthcare system. He argued that Obamacare could “bend the cost curve” of health care down.

It would do so by rationing care through government review boards, which several conservatives including Sarah Palin labeled “death panels.” Setting aside those barbed semantics, it seemed to me that Orszag’s whole approach to American healthcare was not only beside the point but dangerously so.

The problem with American healthcare, from my point of view, was not a lack of government meddling but a surplus of it. About half of all funds spent on healthcare in this country come from federal, state and local governments and those funds come with some pretty crazy strings attached.

U.S. governments arguably underpay for medical services and so those people with private and employer provided insurance have to make up the difference through increased premiums and fees and — let’s not forget — lower wages.

Regulators further bump up premiums by closely scrutinizing all the ailments that insurance companies “must cover.” They also force emergency rooms and the like to serve everyone, regardless of ability to pay.

The emergency room requirement might not be so bad if it were limited to true, life-threatening medical emergencies. In practice, people without insurance know that they can go to the emergency rooms and not be turned away. So they end up going there with any ailment and creating nightmarishly long lines for people with true emergencies.

Then there is our legal system, which is a true bonanza for trial lawyers. Doctors have to keep up an insane amount of paperwork to prevail in these lawsuits and their liability premiums can be debilitating. New drugs are so expensive largely for the same reason.

And don’t forget the third party payer problem. Most health dollars spent come from government or government-regulated insurance. There is little incentive for patients to shop around and thus impose normal price discipline. That’s the reason hospitals can get away with $6 aspirins.

Orszag took in this true cornucopia of problems and said, You know, the real issue is that there is not enough government control. All of the parties should be forced to behave in certain ways and voila! the costs will come down.

So now Orszag turns to K-12 education, a field much more thoroughly dominated by government than even healthcare. He finds that the kids are getting “dumber and fatter during the vacation.” Though he says he has no intention to “declare war on summer,” he really would like to extend the school year and all but eliminate summer breaks.

Let’s grant that there is some evidence of summer slippage. But to look at the vast wasteland that is American public education — the poor teaching, the awful curriculum, the low standards, the anemic achievement, the institutional resistance to needed reform — and say that the real problem is summer vacation takes a special sort of mind.

One hopes the next time Orszag is called on to give expert testimony, he’ll be taking the short bus to Congress.

  • http://www.researchonreligion.org Tony Gill

    Ending summer vacations would destroy the timeless traditions of summer camps. I happen to think that kids learn a ton of useful skills at BSA summer camps and would hate to see that end.

    On the health care front, while I agree with all of your points, I must note that one of the unnoticed problems with the expense (cost curve) of health care is something that actually can’t be solved. As medical science gets better and better at keeping us alive longer and longer, the costs associated with end-of-life care increase. Those end-of-life care costs have decreasing marginal benefits (hence people are right to be scared of “death panels” if bureaucrats control costs). If you put those end-of-life costs aside, and examine what we get for what we pay, medical care has actually decreased over time. Stents, a life-saving device for opening veins and arteries, used to be something only the rich could afford. Now they are commonplace. (Yes, I am aware of some of the medical research over stents.) But think about pacemakers, hearing aids, lasik eye surgery, dental care, a whole variety of drugs, etc.

    There is much we can do to reduce costs by freeing the medical sector from government regulation, but we should not expect to see dramatic cost reductions overall and in end-of-life issues simply because of the nature of the product/service and our success in innovation.

    • CBDenver

      According to the Medical Expenditure Panel Survey, associated with the US government, “medical expenditures tend to be concentrated on the treatment of specific chronic conditions. [T]he top five costly conditions in 1996 and 2006. The top five conditions—heart conditions, cancer, trauma-related disorders, mental disorders, and asthma. http://meps.ahrq.gov/mepsweb/data_files/publications/st248/stat248.pdf

      The idea that the US spends inordingate amounts of money on end-of-life care is not supported by the data. Care for chronic conditions and accidents (trauma-related conditions) top the list of medical expenditures consistently from 1996 to 2006.

  • Jay

    To the left, market failure can only be cured by more government. Government failure can only be cured by more government.

    It makes your list of solutions very easy to keep track of.

  • Jason

    I think Orszag should pay attention to his kids, and not tell us how to take care of our own.

    Orszag is married to Bianna Golodryga, co-host of ABC’s Weekend Good Morning America.[22] They have a son, Jake Spencer Orszag, born in April 2012.[23]
    Orszag’s first marriage was to Cameron Hamill, with whom he had two children.[24][25] They later divorced.[25][26] He also has a child with a former partner, Claire Milonas.[25][27][28]
    Economists Alan Blinder (who taught him at Princeton) and Joseph Stiglitz were his mentors early in life, and later Robert Rubin.[29]
    Orszag runs marathons and enjoys country music.[29][30

  • Charlie

    “Let’s grant that there is some evidence of summer slippage.”

    Funny that the two areas of US life most screwed up–medicine and education–are the two that Progressives had made the most headway with by the 1920s. In both cases, the correct solution lies in backing out the “improvements” made so far by our leftist friends, not by allowing them more leeway to tinker. In medical terms, we need a progressivectomy.

    Public education: In the late 1800s, Progressive Horace Mann brought the Volkschule from Germany as the model for a new educational system to replace the very American Little Red Schoolhouse. He found no takers. So, he started peddling it to state legislatures as a way to deal with “the immigrant problem,” and, boom, he was in business. Progressive John Dewey added some flourishes to make certain it served as an assembly line for turning out finely finished cogs for the great American machine work of his dreams, and voila, the public schools we all know and love to this day, hating to take a break even for summer romping.

    Only, the Volkschule had been purposely designed to make non-aristocratic Germans good statist worker bees. It was the brainchild of J. G. Fichte, widely considered the Ur-Vater of Naziism, after Napoleon demolished the notion of Prussian invincibility at Jena in 1805. Fichte diagnosed the problem as tradesmen and farmers too competent and thus independent. They didn’t need the state. Among his fixes were bells to mark periods to enforce a sense that your time is not your own, grades to condition you to submitting your work for the approval of others and in return for only valueless and arbitrary symbols, rows and columns of desks to create a sense of isolation within regimentation, homework to enforce the sense that even your homelife is not immune to state intrusion, and, most importantly, an arbitrary curriculum with no processes taught start-to-finish to insure that useful trade skills are not learned. And here, 200 years later, it’s barely changed at all.

    Medicine. About 1910 Progressives Carnegie and Rockelfeller financed Progressive Abraham Flexner on a tour of all the medical institutions in North America. Out of this trip came a report to Congress and a book written in muckraking expose style. The resulting hearings in Congress ended with half the medical schools in the US, all those not founded on the principles of the German physician Koch as instituted at Harvard and Johns Hopkins, were shuttered, including all schools of alternative medicine.

    One outcome to this was to privilege WASP males with being physicians (females and non-WASPs could attend the schools of osteopathic medicine that survived). Another outcome, revered to this day by hospital finance people, is that our model of physician as god and gatekeeper was born. Congress agreed with the medical profession that only doctors should decide on remedies, and so many effective remedies, remedies you can buy off-the-shelf to this day in other countries, were moved out of reach of the customer–unless the gatekeeper go his cut first. Now, this is not all that’s wrong with medicine, but it does stand as the first big kink put in the profession by Progressives. Many others have been added since. They all deserve to go.

    • teapartydoc

      About time someone besides me was saying this. The main thing you forgot is that physician licensing by the government started after this and that led to the need to control substances used in medical care and eventually the drug war.

  • Charles Baylor

    Orszag’s thinking on public policy issues runs the gamut from Beavis to Butthead. The only real danger is that someone might actually take him seriously. That doesn’t seem very likely to me.

  • Mike

    You are right, doctors have to keep up an insane amount of paperwork. Legal liability also requires them to perform an insane amount of expensive testing for low probability risks.

    In addition, government insurance programs because of their size and power to jail or revoke licenses tend to make many of the precedent setting decisions. Decisions like paying less for a tonsillectomy than the standard of care materials cost.

  • Tblakely

    From my understanding much of the accelerating medical costs are from government meddling, a lack of a true free-market and astronomical malpractice insurance costs. Until those problems are resolved don’t expect anything but higher costs. Frankly I don’t think reform is politcally possible. I think the system will continue to totter along until it collapses when financial realities catch up. What happens after that is anybodies guess.

  • http://econlog.econlib.org/archives/2012/07/california_land.html David R. Henderson

    Orszag’s beef reminds me of the old joke about two women complaining about their vacation in the Catskills.
    Women 1: The food was terrible!
    Women 2: Yes, and the portions were so small.

  • Walter Sobchak

    Have you ever seen Orszag without his toupee? And the way he treated his first girlfriend and his child.

    A beating would be more like it.

  • Ryan Booth

    Slippage is a big problem, particularly in math. Students reading skills really don’t drop much over the summer, because summer reading programs are common, but kids lose an average of 2.5 months off their grade level in math every summer.

    Orszag’s prescription of a longer academic year is unnecessary, though, at least for most students. A better solution, at least in the short term, is to increase breaks during the school year and shorten the summer break. Have a week of Fall Break in mid-October, give the kids the whole week of Thanksgiving off, and add in a second break in the spring. Then summer vacation is only two months, and there’s less slippage—and still plenty of time for summer camp.

  • waterfowl

    CBDenver,

    The idea that the US spends inordinate amounts of money on end-of-life care is not supported by the data. Care for chronic conditions and accidents (trauma-related conditions) top the list of medical expenditures consistently from 1996 to 2006.

    The prior problem here is that if you try to save people who are very, very sick, or very badly injured, some of them will die anyway, and definitionally anything you spent trying to save them is “end-of-life care.” The harder you try to save those in desperate need of help, the higher the fraction that will die anyway, and the higher the “end-of-life care” figure.

    We could eliminate the “end-of-life care” figure almost entirely by refusing medical care to anyone who looked sick enough that you wouldn’t put even odds on his/her lasting out the month. That would certainly improve the international health care comparison stats that appear to be what many people care about most. OTOH …

    A few years ago, my dad had a bout of interstitial pneumonia. He was in the ICU, ventilated and intubated, for a week; had to go back into hospital a couple of months later; was on the lung transplant list for several more months. Eventually his lungs healed enough that he was off the transplant list. He’s now capable of four-mile walks, and well enough that he and my mom were able to take a trip to the Antarctic last winter, and to the Amazon a few months ago. (In retirement, they’ve both become serious nature photographers.)

    But had my father died in the ICU (and it looked bloody likely for a while), everything done to try to save him would have been counted as “end-of-life care.” As he didn’t, it doesn’t. But if it hadn’t been done, even at the cost of maybe making the hospital’s cost-sheets look bad, he would not be alive.

  • Marty

    Orszag is a great example of what happens when a liberal tries to think–not very good at it and the results are amusing.

    Of course, start following their advice or give them the power to compel it, you have big problems.

  • Mycie14

    I think Pete is the one who needs more education. His statement that if “the federal government pays half it will only cost taxpayers 2 billion”, seems to indicate that he doesn’t understand where the federal monies come from. And he doesn’t seem to be aware of the tremendous deficits the federal government is already running.

  • nerdbert

    I live in Minnesota.

    We have 5 months a year when you can comfortably be outside without serious bundling.

    And this idiot wants to take that away? They’ll get my summer vacation when they pry it from my cold, dead fingers. I’ll go home schooling first.

  • Boris_Badenoff

    Of course Orszag’s proposal is unfounded – putting forth doubtful remedies to imagined problems is the bread and butter of the left.

    But of course the real intent is to force an instant 20% increase in every public education budget.

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  • CJ

    Not an Orszag fan and agree with a lot of the comments here, but may I say this … we need to find a way to get people graduated from high school and university, and into productive work, earlier in life. What we have now is people who are 30 years old by the time they get out of university, and bored high schoolers spinning their wheels while they don’t learn a thing. It’s all bad.

  • Buzz

    Okay, a bit off-topic, but I’m tired of “short bus” jokes. My son took the short bus to school, meaning he was part of the special needs students, some of whom need wheelchairs, hence the “short bus” with the special wheelchair lift.

    My son is developmentally delayed cognitively, what we used to in pre-PC days refer to as “mentally retarded.” Because he cannot learn as fast as others and cannot grasp some subjects, particularly abstract topics, does not mean he is stupid in the sense you mean it with Orzag. My son is incapable of grasping abstracts such as you discuss; Orzag is. That means my son is merely uneducated while Orzag is foolish. The first is no crime; the second is, particularly with our tax money.

    I agree with your point, but I’m tired of people making jokes they don’t understand.

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